Education, Practice, and Organization of Healthcare in the 21st Century

Understanding Values in a Large Health Care Organization through Work-Life Narratives of High-Performing Employees

Orit Karnieli-Miller, Amanda C. Taylor, Thomas S. Inui, Steven S. Ivy and Richard M. Frankel


Objective. To understand high-performing front-line employees’ values as reflected in their narratives of day-to-day interactions in a large health care organization. Methods. A total of 150 employees representing various roles within the organization were interviewed and asked to share work-life narratives (WLNs) about value-affirming situations (i.e. situations in which they believed their actions to be fully aligned with their values) and value-challenging situations (i.e. when their actions or the actions of others were not consistent with their values), using methods based on appreciative inquiry. Results. The analysis revealed 10 broad values. Most of the value-affirming WLNs were about the story-teller and team providing care for the patient/family. Half of the value-challenging WLNs were about the story-teller or a patient and barriers created by the organization, supervisor, or physician. Almost half of these focused on “treating others with dis/respect”. Only 15% of the value-challenging WLNs contained a resolution reached by the participants, often leaving them describing unresolved and frequently negative feelings. Conclusions. Appreciative inquiry and thematic analysis methods were found to be an effective tool for understanding the important and sometimes competing role personal and institutional values play in day-to-day work. There is remarkable potential in using WLNs as a way to surface and reinforce shared values and, perhaps more importantly, respectfully to identify and discuss conflicting personal and professional values.

Rambam Maimonides Med J 2011;2(4):e0062